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Paul Weiss

disregard the fact that each thread or wire stitch represents a potential path of penetration for fibrous tissue and of escape for regenerating fibers, interference with the stress pattern is an unavoidable consequence of suturing. For one thing, the drawing together of the stumps gives rise to that undesirable transverse pressure pattern just mentioned. Moreover, since all traction between the stumps is transmitted through the rigid suture threads, it bypasses the union tissue at the suture line and deprives it of the beneficial influence of longitudinal tension. The

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Richard Upjohn Light

of an active prepared thrombin to the flowing blood at the point of its emission. Two good reasons dictate this choice rather than any other. First, the occasional defects of the clotting mechanism lie almost exclusively in the preliminary steps by which thrombin is formed, and such defects (hemophilia, jaundice, etc.) are thus circumvented if the first reaction is by-passed. Second, the reaction between thrombin and fibrinogen is the last step in the process, and it goes forward with considerably more force and speed than does the reaction to an artificial

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Extensive Brain Wounds

Analysis of 159 Cases Occurring in a Series of 342 Penetrating War Wounds of the Brain

Walter G. Haynes

stamps being sufficient to stop the flow of blood. On one patient, memorable because of the technical difficulties involved, operation was attempted twice. The first was carried out through the original defect, by-passing the torn torcular to clean out a large, midline, occipital, missile tract down to the midbrain. Furious hemorrhage, controlled with great difficulty, met this attempt. The wound was closed and 36 hours later an approach lateral to the tract was attempted. Again, the torn sinus ends bled furiously. The operation, of necessity, ceased, to await the

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W. James Gardner, Averill Stowell and Robert Dutlinger

neuralgia,” Ramsey Hunt 13 described pain deep in the ear and deep in the face. The presence of unilateral head pain was not stressed in this syndrome. He did not take into account the work of Cobb and Finesinger 3 and Chorobski and Penfield 1 on the anatomy and physiology of the greater superficial petrosal nerve, most of whose fibers lie in close proximity to but actually by-pass the geniculate ganglion. Fay 7 described the syndrome of atypical facial neuralgia and his operative procedures in 19 cases in an attempt to relieve it. The neuralgia which he was

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James G. Golseth and James A. Fizzell

electrodes developed conducting paths through themselves as a result of the retention of electrolytes from the sterilization process and that this fact could not be detected except by some additional testing procedure. Occasionally, these conducting paths by-passed so much of the current that normal muscle in the operative field could not be made to contract even when the voltmeter was set to its maximum value. As a result of this experience, we have devised a small portable instrument with appropriate electrodes for direct nerve stimulation which overcame the above

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W. H. Sweet and H. S. Bennett

transmitted from the needle by flexible non-distensible Saran tubing filled with fluid to a glass membrane optically recording manometer equipped with a hydraulic integrator bypass system. The apparatus has been fully described by Bennett, Bassett, and Beecher. 2 This recording system permitted one to record faithfully and continuously at will either a full pulse pressure or an integrated mean pressure, with ready and speedy conversion from either form of recording to the other. The needle was frequently irrigated with normal saline solution containing heparin in order to

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The Torkildsen Procedure

A Report of 19 Cases

Edgar F. Fincher, Gordon J. Strewler and Homer S. Swanson

S ome ten years have elapsed since Torkildsen performed his new palliative operation for by-passing Sylvian aqueductal obstruction. On September 9, 1937, 24 he carried out a ventriculocisternostomy on a 36-year-old man with an inoperable occlusive lesion of the aqueduct of Sylvius. This release of the acquired hydrocephalus was accomplished by inserting one end of a rubber catheter into the posterior horn of the lateral ventricle and carrying the tube beneath the scalp, over the lateral sinus, and suturing its distal end into the cisterna magna. While this

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Ira Cohen

When obstructive hydrocephalus in adults is due to a lesion that is not removable, one of two palliative procedures may be employed. The obstruction may be by-passed by a tube leading from the lateral ventricle into the cisterna magna, as described by Torkildsen. 5 Or the accumulation of excess fluid in the ventricle may be prevented by opening a communication between the 3rd ventricle and the basal cisternae. This procedure, first described by Dandy 1 in 1922, was devised for congenital hydrocephalus in older age groups. Among others its use has been

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Further Studies on the Treatment of Experimental Hydrocephalus

Attempts to Drain the Cerebrospinal Fluid into the Pleural Cavity and the Thoracic Duct

Franc D. Ingraham, Robert A. Sears, Robert P. Woods and Orville T. Bailey

brain stem, 1 with resultant dilatation of the entire ventricular system and the proximal subarachnoid spaces. This is a true communicating hydrocephalus. Clinically, as well as experimentally, attempts at surgical relief for either of these conditions have been directed either at the removal of varying portions of the choroid plexuses, or at by-passing the block. In the by-passing operations, the fluid is led either to the subarachnoid space beyond the block, or to a surface outside the nervous system which is capable of absorbing or draining the fluid. The

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Intracranial Aneurysms

I. Some Clinical Observations Concerning their Development

Robert C. Bassett

development of the primitive cerebral vascular network offering through the complexity of its genesis a more simple and logical explanation for these anomalies. 1, 17 Some writers, having noticed the presence of anomalous vessels, have by-passed the significance of these structures; others, however, have emphasized their importance. 1, 5, 6, 9, 11, 12, 14 The following cases illustrate the point in question: Case 1 . F. M., 24-year-old white male. The aneurysm arose from the mid-portion of the left posterior inferior cerebellar artery and had blown out into the left